Provider Demographics
NPI:1639576507
Name:BESINGER, AMANDA SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUZANNE
Last Name:BESINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUZANNE
Other - Last Name:BESINGER GAWRIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MSW
Mailing Address - Street 1:820 N ORLEANS ST STE 206
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3144
Mailing Address - Country:US
Mailing Address - Phone:312-809-0298
Mailing Address - Fax:
Practice Address - Street 1:820 N ORLEANS ST STE 206
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3144
Practice Address - Country:US
Practice Address - Phone:312-809-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102130104100000X
222Q00000X
IL149.0211131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist